Spring activated hemostatic clip applicator

ABSTRACT

A surgical clip applying device having a main body, a clip magazine coupled to the main body for holding a plurality of clips, clip deforming jaws coupled to the main body for receiving and deforming clips, a clip loading mechanism for loading clips from the magazine to a clip feed blade which moves clips from the clip magazine to the deforming jaws, and a spring activated actuating mechanism. The clip loading mechanism includes a double ratchet apparatus coupled to a pawl for advancing the clips through the magazine. The actuating mechanism includes handle portions, a ratchet member having a cam follower which is coupled to a camming surface which is in turn coupled to one of the handle portions, a spring connected to the main body and the ratchet member, and a latch adapted to engage the ratchet member. By movement of one of the handle portions with respect to the other handle portion, the camming surface engages the cam follower to store energy in the spring, which is retained therein via engagement of the latch with the ratchet member. In operation, a slight movement of one of the handle portions with respect to the other handle portion disengages the latch from the ratchet member so that the energy stored in the spring is converted into rapid forward movement of the clip feed blade. This forward movement causes the clip loading mechanism to advance a clip and, in addition, causes the clip feed blade to slide through the magazine to rapidly place a clip in the deforming jaws.

BACKGROUND OF THE INVENTION

1. Copending Patent Applications

This is a division of application Ser. No. 433,028, filed on Oct. 6,1982, now U.S. Pat. No. 4,522,207, which is a continuation-in-part ofapplication Ser. No. 231,976 entitled Spring Activated Hemostatic ClipApplicator, filed on Feb. 6, 1981 now abandoned, which is acontinuation-in-part of application Ser. No. 183,360 entitled HemostaticClip Applicator, filed on Sept. 2, 1980 U.S. Pat. No. 4,325,376, whichis a continuation of application Ser. No. 822,076 filed on Aug. 5, 1977,and now abandoned.

In U.S. Pat. No. 4,188,953 entitled Hemostatic Clip, issued on Feb. 19,1980, and assigned to the present assignee, hemostatic clips adapted forutilization in the present invention and similar devices is disclosed.

In the above-referenced copending U.S. patent application entitledHemostatic Clip Applicator, and assigned to the present assignee, aHemostatic Clip Applicator for the strangulation of tubular members in arapid and automatic manner is disclosed. That application is directed,in part, to a device having a main body, a clip cartridge, actuatinghandles, and clip deforming jaws. Disposed within the clip cartridge area plurality of hemostatic clips, and a clip feed means which moves clipsto the clip deforming jaws where the clips are deformed about a bloodvessel or the like.

While the applicator noted in the preceding paragraph provides a novelmethod for automatically closing blood vessels and other fluid ducts, itrequires the manual feeding of a hemostatic clip into the deforming jawsby the forward movement of one of two handles. That is, to operate thatdevice, the surgeon must first move one of the handle portions to aforward position so as to load a hemostatic clip in the deforming jaws,and then return that handle portion to its neutral position. Once thesurgeon has located the hemostatic clip around the tubular member to beclosed, he squeezes both handle portions together resulting in thecrimping of a clip about the blood vessel. When the surgeon is ready toclose another blood vessel, this same sequence of moving one handleportion forward and then rearward must be repeated so as to sequentiallyload and close a clip.

In the other above referenced copending U.S. patent application entitledSpring Activated Hemostatic Clip Applicator, and assigned to the presentassignee, an alternative hemostatic clip applicator is disclosed whichalso provides for the rapid and automatic strangulation of tubularmembers. That application is directed, in part, to a device in whichenergy is first stored and then released to automatically deliver a clipinto the jaws of the instrument. In the illustrated embodiment of thatapplication, with a slight upward movement of one of the finger loops, aclip is almost instantaneously delivered to the jaws of the instrumentby the release of energy stored in a spring. Then, simply by moving thefinger loops toward one another, the clip which has been loaded in thejaw portions can be deformed around a blood vessel or the like.Simultaneously with this crimping of the hemostatic clip, the instrumentis again storing energy in the spring so that when another clip isneeded, it can be readily available.

While this last noted clip applicator also provides a novel method forautomatically closing blood vessels and other fluid ducts, it has beenfound that a noticeable additional force has often been necessary to"cock" the spring over and above that which is required to crimp theclip. This has resulted, in part, from the utilization of a spring whichis capable of exerting a force sufficient to overcome frictional forcesexerted by elements within the clip magazine. In particular, in theillustrated embodiment of this latter application, the clips in themagazine are pushed forward by a pawl which is engaged by a forwardmoving member which is coupled to the spring. The pawl also prevents theclips from moving backwards while the spring is being cocked. In thatembodiment, the pawl is prevented from moving backward by the frictionalengagement of two side arms disposed on either side of the pawl with themagazine housing walls. This frictional engagement of the pawl sidearmsmust be overcome by the spring in order to drive the pawl andconsequently, the clips, forward. Since the force necessary to cock thespring increases the force necessary to close the finger loops and crimpthe clip, it is desirable to minimize the requisite strength of thespring to minimize the cocking force of the spring.

It is toward the refinement of the devices disclosed in the copendingU.S. patent applications noted above that the present invention isdirected, and more specifically, toward a device which rapidly, yetalmost effortlessly, loads and crimps a hemostatic clip in the deformingjaws of the instrument.

2. Field of the Invention

The invention relates to the field of devices useful in the applicationof hemostatic clips, and more specifically, to devices for theapplication of hemostatic clips used in the strangulation of bloodvessels and other fluid ducts.

3. Prior Art

In a typical surgery procedure, a great many veins, arteries, and otherblood vessels must be severed and closed. This is often a difficult andtime consuming procedure since many vessels are located in obscure areaswhere there is little room in which to work. Thus, it is apparent that adevice which would reduce the time required for closure of blood vesselswould be a great benefit to both surgeon and patient.

One prior art attempt to provide a device which can more rapidly close ablood vessel is suggested by Jarvik, U.S. Pat. No. 4,146,466. The Jarvikdevice has a channel in the main body of the instrument which isintegral with one of the jaws of the instrument. In the Jarvik device, aslip pusher moves the lower most clip in a clip stack through thechannel in the main body to the jaws at the far end of the instrument.However, the pusher does not enter the jaws of the Jarvik instrument,but merely abuts the aft-most portion of the jaws without slidingtherebetween. As a result, the jaws of the instrument are approximatelythe same length as the length of the clips, which can reduce visibilityfor the surgeon. In addition, upon application of the hemostatic clip bythe Jarvik instrument, the pusher is positively prevented from returningfrom its farthest most position. Also, the Jarvik patent does notdisclose an instrument which utilizes a spring loaded mechanism so as tomove rapidly and accurately a clip from an internal clip magazine to thejaw portions of the instrument.

Accordingly, it is a general object of the present invention to providean improved hemostatic clip applicator device for the strangulation ofblood vessels and the like.

It is another object of the present invention to provide an improvedautomatic hemostatic clip applicator device which provides highvisibility to the surgeon.

It is another object of the present invention to provide an improvedhemostatic clip applicator device which rapidly and automatically feedsclips to its forward portion and then provides deformation of the clipsabout blood vessels.

It is yet another object of the present invention to minimize thefriction in the operation of an automatic clip feeding hemostatic clipapplicator.

It is still another object to provide an improved automatic clip feedinghemostatic clip applicator which simulates the feel of a manualhemostatic clip applicator.

It is another object to provide an improved cartridge which minimizesresistance to the advancement of each clip.

SUMMARY OF THE INVENTION

A hemostatic clip applicator device useful for rapidly and automaticallyapplying clips for the strangulation of blood vessels and the like isprovided. The device has a clip magazine coupled to the exterior of amain body, the clip magazine being adapted to hold a plurality ofhemostatic clips. Attached to one end of the main body are clipdeforming jaws adapted to hold and crimp a hemostatic clip about a bloodvessel. Slideably disposed within the clip magazine is a clip feed meanswhich is adapted to move clips from the magazine to the clip deformingjaws. The clip magazine has a clip loading means which sequentiallyloads the clip feed means with hemostatic clips from the magazine.Coupled to the clip feed means, the clip loading means and the clipdeforming jaws is an actuating means. The actuating means includeshandle portions coupled to the main body and an energizing means coupledto the main body, the clip feed means, the clip loading means and thehandle portions. The energizing means is adapted to store energy andselectively supply that energy to the clip feed means and clip loadingmeans.

By a slight outward movement of one of the handle portions, theenergizing means is activated to supply the stored energy to the clipfeed means so as to cause one of the clips stored in the clip magazineto be moved rapidly to the clip deforming jaws. The stored energy isalso supplied to the clip loading means such that the next clip in themagazine is advanced for loading to the clip feed means. Once located inthe clip deforming jaws, the clip can be crimped about a blood vessel orthe like simply by moving the handle portions toward one another. As aconsequence of this squeezing of the handle portions toward one another,energy is again stored in the energizing means so as to be available fora subsequent rapid placement of the next clip in the deforming jaws.This sequence of rapidly feeding clips to the clip deforming jaws andcrimping them, may be repeated until the plurality of clips located inthe clip magazine is depleted.

In comparison with the automatic clip applicator device disclosed in ourco-pending U.S. application Ser. No. 281,976, the present inventionreduces the force necessary to squeeze the handle portions together, bywhich the clips are crimped in the clip deforming jaws and the energy isstored in the energizing means. This is accomplished by reducing thefriction exerted by the clip loading means, which must be overcome bythe energizing means to effectuate the loading of a clip. As a result,the force required to be exerted by the energizing means and,consequently, the energy required to be stored by the energizing means,are correspondingly reduced. In the illustrated embodiment, the improvedclip loading means includes a pair of ratchet bars in which one bar ismoved in a reciprocating motion relative to the other by the energizingmeans. In addition, a pawl means is provided between the ratchet bars,which is adapted to alternately engage the ratchet bars in conjunctionwith the reciprocating motion of the ratchet bars to advance the clipsheld within the magazine.

In another aspect of the present invention, the force necessary tosqueeze the handle portions together is also reduced by an improvedenergizing means. The energizing means includes a camming surfacecoupled to one of the handle portions and a low friction cam followercoupled to an energy storage means such as a spring. As the handleportions are squeezed together, the camming surface engages the camfollower which causes energy to be stored in the energy storage means ina particularly low friction manner.

The novel features which are believed to be characteristic of theinvention, both as to its organization and its method of operation,together with further objects and advantages thereof, will be betterunderstood from the following description in connection withaccompanying drawings in which a presently preferred embodiment of theinvention is illustrated by way of example. It is to be expresslyunderstood, however, that the drawings are for the purposes ofillustration and description only and are not intended as a definitionof the limits of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of the clip applicating device of the presentinvention with a portion broken away;

FIG. 2 is an enlarged view of the broken away portion of the applicatingdevice cf FIG. 1;

FIG. 3 is an exploded view of the energizing mechanism of theapplicating device of FIG. 1;

FIG. 4 is a pictorial view of the cam follower portion of the ratchetconnecting member of the applicating device of FIG. 1;

FIG. 5 is an exploded view of the clip magazine of the clip applicatingdevice of FIG. 1;

FIG. 6 is an enlarged pictorial view of the pawl of the clip magazine ofFIG. 5;

FIG. 7 is a cross-sectional view of the forward section of the clipapplicating device taken along the lines 7--7 of FIG. 1;

FIG. 8 is a cross-sectional view of the forward section of the clipapplicating device taken along the lines 8--8 of FIG. 1;

FIG. 9 is a side cross-sectional view of the clip applicating devicetaken along the lines 9--9 in FIG. 8;

FIG. 10 is a side view of the clip applicating device of FIG. 1illustrating the device in its configuration immediately following therapid loading of a clip into the jaws of the device;

FIG. 11 is an enlarged cross-sectional view of the forward portion ofthe clip applicating device taken along the lines 11--11 of FIG. 10;

FIG. 12 is a side cross-sectional view of the clip applicating device inits configuration as illustrated in FIG. 11;

FIG. 13 is a side view of the clip applicating device of FIG. 1illustrating the simultaneous crimping of a hemostatic clip and thecocking of the energizing mechanism;

FIG. 14 is a cross-sectional view of the forward section of the clipapplicating device of FIG. 1 illustrating the position of elements ofthe magazine at a time subsequent to that shown in the configuration ofFIG. 13; and

FIG. 15 is a side cross-sectional view of the clip applicating devicetaken along the lines 15--15 of FIG. 13.

DETAILED DESCRIPTION OF THE INVENTION

A spring activated hemostatic clip applicator device is disclosed whichis useful in rapidly applying a sequence of hemostatic clips about bloodvessels and other fluid ducts. The hemostatic clip applicator of thepresent invention may be used with hemostatic clips such as is describedin our U.S. Pat. No. 4,188,953 issued on Feb. 19, 1980, entitled"Hemostatic Clip", or with any other suitably adapted hemostatic clip.

Referring to FIGS. 1, 2 and 3 the spring activated hemostatic clipapplying device 2 of the present invention is shown with its actuatingmeans in its "cocked" configuration. The actuating means is comprised ofan energizing means, and handle portions. In the presently preferredembodiment, the energizing means is comprised of ratchet connecting rodor member 50, ratchet spring 58, and latch 54. The handle portions arecomprised of an upper finger loop 4 and upper finger loop member 5,along with lower finger loop 6 and lower finger loop member 7. Upperfinger loop 4 and upper finger loop member 5 are integral with main body20.

As will be more fully described hereinbelow, clip feed blade 18 is aclip feed means which in the presently preferred embodiment is a blademember adapted to slide rapidly through clip magazine means 102 and intothe forward portions (i.e., those portions to the left in FIG. 1) ofdevice 2. Also, as will be described more fully hereinbelow, the rapidmovement of clip feed blade 18 into the forward portions of device 2,and the corresponding movement of a hemostatic clip into the jaw members32, 34 of device 2, is accomplished merely by activating the energizingmeans of the present invention.

Disposed within clip magazine means 102 are a plurality of hemostaticclips 37 (FIG. 9), and magazine 102 is adapted such that the individualclips are available to be moved forward by clip feed blade 18. Springguide means 100 aids the movement of a clip from magazine 102 into themain body 20 of instrument 2.

Coupled to the forward portion of main body 20 is a clip deforming meansadapted to deform a hemostatic clip 37 about a blood vessel or the like.In the presently preferred embodiment, the clip deforming means iscomprised of upper jaw portion 32 and lower jaw portion 34. Upper jawportion 32 is fixedly coupled to lower finger loop member 7 andpivotally coupled to main body 20 by upper jaw pivot 36, while lower jawportion 34 is fixedly coupled to main body 20. When a hemostatic clip 37has been fed from the clip magazine 102 into grooves 40 and 42 (FIG. 9)of jaw portions 32 and 34 by the interaction of clip feed blade 18 andthe energizing means, the clip may be squeezed about a blood vessel bysqueezing finger loops 6 and 4 together so that upper jaw portion 32closes toward lower jaw portion 34.

Now referring more particularly to the energizing means of the presentinvention, reference is made to the main components of the energizingmeans--ratchet connecting member 50, latch 54, latch spring 56, andratchet spring 58. As illustrated in FIGS. 1-3, ratchet member 50 iscoupled to clip feed blade 18 by means of ratchet member pin 17 insertedinto slot 23 of clip feed blade 18. The ratchet connecting member 50 isalso coupled to lower finger loop 6 by cam follower 62 at the end of theratchet connecting member. The ratchet connecting member 50 is slidablycarried in a longitudinal groove 25 defined by cover plate 22 and mainbody 20 when assembled as indicated in FIG. 3. The main body 20 has awindow 27 through which the cam follower 62 extends. The lower fingerloop member 7 includes recess 29 which defines the camming surface 26.The cam follower 62 of ratchet connecting member 50 extends into thisrecess 29 from window 27 of main body 20. One end of ratchet spring 58is coupled to main body 20 by pin 60 of cover plate 22, while the otherend is coupled to ratchet connecting member 50 by slot 24. Ratchetspring 58 is carried in a groove 31 defined by cover plate 22 andratchet connecting member 50 when assembled.

In the configuration illustrated in FIGS. 1 and 2, energy has beenstored in the stretched ratchet spring 58, that energy being directedtoward the forward movement of ratchet member 50 in groove 25 and thecorresponding forward movement of clip feed blade 18. Energy remainsstored in spring 58 because forward movement of ratchet member 50 isprevented by the engagement of latch 54 with the teeth or serrations 52of ratchet 50. Latch 54 is held in engagement with ratchet member 50 bythe urging of spring 56, that spring being coupled to main body 20 byrivets 57. In the presently preferred embodiment, ratchet spring 58 is ahelical spring, although other types of springs could be readilyutilized.

In operation, a slight movement of lower finger loop 6 away from upperfinger loop 4 causes the lower edge 9 of lower finger loop member 7 toengage latch 54 and rotate latch 54 about pin 55 in a clockwisedirection. This clockwise rotation of latch 54 causes latch 54 todisengage from the teeth 52 of ratchet member 50. With the removal ofthe impediment of latch 54, ratchet spring 58 is free to contract anddrive ratchet member 50 forward. This forward movement of ratchet member50 causes clip feed blade 18, coupled to ratchet member 50, to rapidlyadvance through the instrument and thereby immediately place ahemostatic clip 37 in the extreme ends of jaw portions 32, 34. As willbe explained in more detail hereinbelow, the forward advance of clipfeed blade 18 and the ratchet member 50 is controlled and fixed by theabutment of the cam follower 62 with the forward portion of cam surface26 indicated at 28. Similarly, the rearward reach of clip feed blade 18is controlled by the abutment of rearward stop 16 of lower ratchet bar110, with end tab 13 of magazine 102.

It is important to note from FIG. 1 that the outward movement of upperjaw portion 32 is limited by the stop surface 38 of lower finger loopmember 7 with stop pin 44 of main body 20. Thus, if a hemostatic clip islocated in jaw portions 32 and 34, it may not accidentally be dropped bythe over expansion of upper jaw 32 with respect to lower jaw 34.

Illustrated in FIG. 2 is the relationship of recess 29, cam follower 62,and the window 27 in main body 20. In the condition illustrated in FIGS.1 and 2, lower finger loop 6 is free to travel inwardly and outwardlyabout pivot 36 within the confines of the travel of cam follower 62within the recess 29 of lower finger loop member 7. This freedom ofmovement of lower finger loop 6, and the corresponding freedom ofmovement of upper jaw portion 32 with respect to lower jaw portion 34has the following very useful advantage during a surgery. If ahemostatic clip 37 has been previously applied to a blood vessel or thelike during surgery, and it becomes necessary to further crimp or securethat hemostatic clip 37, the freedom of movement of instrument 2, asillustrated in FIGS. 1 and 2, allows the surgeon to place the previouslycrimped hemostatic clip 37 between jaws 32 and 34 and make furthercrimping adjustment as necessary.

Finally, in reference to FIG. 2, it can be seen that cam follower 62 isfree to move through window 27 in main body 2 when the latch 54 isreleased. Thus, when the energizing means induces a forward movement ofratchet member 50 and feed blade 18, cam follower 62 can freely travelfrom right to left in window 27.

FIG. 4 is an enlarged view of the cam follower 62 at the rearward end ofthe ratchet connecting member 50. As seen therein, cam follower 62 hasan axle 46 on which is rotationally carried a roller wheel 47. Couplingwheel 47 to axle 46 is a plurality of roller bearings 48. As will beseen more clearly below, the cam follower 62 of the energizing meansreduces the friction which occurs as the spring 58 is cocked, therebyeasing the force required to squeeze the finger loops together.

FIG. 5 illustrates in greater detail the components comprising the clipmagazine 102 and the clip feeding means of the present invention. Clipmagazine 102 is comprised of a magazine housing 114, containing aplurality of hemostatic clips 37. Located within clip magazine housing114 is lower ratchet bar 110 and clip feed blade 18 between housing 114and lower ratchet bar 110.

Magazine housing 114 is affixed to main body 20 in a cavity 72 (FIG. 7)which has recesses 74a and 74b on either side. Magazine 102 furtherincludes upper ratchet bar 70 which has a pair of dimpled tabs 76a and76b which snap into main body recesses 74a and 74b, respectively. Inthis manner, upper ratchet bar 70 couples the magazine 102 to main body20.

The clips 37 are aligned in a single forward facing row between ratchetbars 70 and 110. A pawl 122 is positioned behind the rearward most clipof magazine 102 and is provided to urge the clips forward. As will bemore fully explained below, pawl 122 is actuated by the reciprocatingforward and backward motion of lower ratchet bar 110 which is in turnmoved by clip feed blade 18. As seen more clearly in FIG. 6, pawl 122has a downwardly extending resilient tab 78 and an upwardly extendingresilient tab 80. The tabs 78 and 80 alternately engage the recesses orholes 82 and 94 of ratchet bars 110 and 70, respectively, to advance theclips 37 forward, in conjunction with the reciprocating motion of thelower ratchet bar 110. The forward most clip is positioned by guidespring 100 and leaf spring 112 in front of clip feed blade 18.Completing magazine 102 of the illustrated embodiment is cover bar 96which is affixed to housing 114 by housing tabs 90 bent over intocorresponding recesses 86 of cover bar 96.

FIG. 8 is a cross-sectional view of the forward portion of clip applyingdevice 2, as taken along lines 8--8 of FIG. 1. In the forward mostportion of FIG. 8, it can be seen that there is a groove 40 disposedwithin upper jaw portion 32. Groove 40 in conjunction with thecorresponding groove 42 (FIG. 9) in lower jaw portion 34 serves to guideand secure a hemostatic clip 37 as it is rapidly moved from the mainbody 20 of instrument 2 to the forward most portions of jaws 32, 34.

It can be seen from FIG. 8 that the forward movement of clip feed blade18 through magazine 102 will move hemostatic clip 37' from its keyposition 125 through lower jaw portion groove 42 and ultimately to theextreme end of lower jaw portion 34. As illustrated in FIG. 8, jawportions 32 and 34 can be curved away from main body 20 to allow bettervisibility during usage. Thus, feed blade 18 must be configured so as tobe capable of being moved forward through grooves 40 and 42 whilesimultaneously bending away from main body 20 in grooves 40 and 42. Inthe presently preferred embodiment, this capability has been provided byconstructing feed blade 18 of three layers of thin blades of metal in alaminated configuration. The three layers are only coupled at discreetpoints so that the feed blade 18 is able to move longitudinally throughmain body 20 while curving around grooves 40 and 42 in jaw portions 32and 34.

It can also be seen in FIG. 8 that guide spring means 100 and leafspring 112 are adapted to maintain clip 37' in its key position 125until clip 37' is moved forward by feed blade 18. In addition, the end140 of upper ratchet bar 70 is adapted to maintain clip 37" in itsproper position so that it is available to be moved into key position125 so as to replace clip 37'. The end 140 of upper ratchet bar 70 isbent slightly downward following the taper of housing 114 indicated at150 (FIG. 5).

It can also be seen in FIG. 8 that clip magazine 102 is comprised of asimply constructed housing 114 which is inexpensively stamped from stockmaterial and then attached to the main body 20 by the upper ratchet bartabs 76. Thus, clip magazine 102 is replaceably coupled to main body 20so that when the clips 37 are depleted from magazine 102, that magazine102 can be removed from instrument 2 and a new magazine 102 can beplaced therein.

FIG. 8 also shows that lower ratchet bar 110 is coupled to clip feedblade 18 by means of extension member 109 which extends into slot 84 offeed blade 18. Because ratchet connecting member 50 is in its extremeretracted position, extension member 109 is abutting the extreme leftend of slot 84. Also disposed within clip housing 114 is pawl 122 withits lower tab 78 disposed just ahead of a lower ratchet bar holeindicated as 82'. The upper pawl tab 80 is disposed in a hole 94' of theupper ratchet bar. Pawl 122 is positioned so as to abut the rearwardmost clip 37.

FIG. 9 is a side cross-sectional view of the forward portion of clipapplying device 2 with ratchet connecting member 50 again shown in itsextreme retracted position. In this FIGURE, the clip feed blade lostmotion slot 84 wherein is disposed extension member 109 of the lowerratchet bar, can be seen more clearly. Pawl 122 is shown in its extremerearward position having tab 78 located just ahead of lower ratchet barhole 82'. The leading edge 124 of pawl 122 is configured so as toconform to the bail portion of clips 37. As will be described more fullyhereinbelow, pawl 122 is adapted to move clips 37 forward throughmagazine 102 when lower ratchet bar 110 is moved forward.

Now turning to FIG. 10, instrument 2 is illustrated in its configurationjust following the spring activated loading of hemostatic clip 37' intojaw portions 32, 34. As noted in the discussion of FIG. 1, a slightdownward movement of finger loop 6 with respect to finger loop 4 causeslower edge 9 of lower finger loop member 7 to abut and thereby rotatelatch 54 in a clockwise direction so as to disengage latch 54 from teeth52 of ratchet member 50. Immediately after this disengagement of latch54 from ratchet member 50, the energy stored in ratchet spring 58 causesratchet member 50 to snap forward, and thereby rapidly move clip feedblade 18 through magazine 102, and ultimately move hemostatic clip 37'into jaw portions 32, 34. This rapid forward movement of clip feed blade18 is brought to an abrupt halt, by the abutment of cam follower 62 withstop surface 28 of camming surface 26 at just the point where clip 37'is properly positioned in jaws 32, 34.

It should be particularly noted in FIGS. 5 and 10 that the forward mostend of clip feed blade 18 is split into two sections 21 which arearranged in a forked configuration. The abutment of forked ends 21 ofclip feed blade 18 with the bail portion of hemostatic clip 37' providesthe significant advantage of preventing rearward movement of clip 37'when the clip is being positioned around a blood vessel or the like.Furthermore, the forked configuration of the forward most end 21 of clipfeed blade 18 has the significant advantage of not reducing visibilitythrough jaw portions 32, 34.

FIG. 11 is a cross-sectional view of the forward most section of clipapplying device 2, taken along the lines 11--11 of FIG. 10. Here alsoratchet connecting member 50 has been moved to its full forward positionas in FIG. 10. Because previous forward movement of ratchet member 50and feed blade 18 have brought about abutment of low ratchet barextension member 109 with the rear most end of lost motion slot 84, thefurther forward movement of clip feed blade 18 has resulted in forwardmovement of lower ratchet bar 110. This forward movement of lowerratchet bar 110 causes pawl lower tab 78 to drop in and engage hole 82',resulting in forward movement of pawl 122. Note, since upper ratchet bar70 does not move but is fixed relative to housing 114, the resilientupper pawl tab 80 has been moved down out of the last upper ratchet barhole 94' and has been moved past the next to last hole 94" by theforward movement of pawl 122. The forward movement of pawl 122 has, inturn, caused forward movement of clips 37 disposed within magazine 102.The initial movement of lower ratchet bar 110 before pawl 122 movesallows a tolerance in the dimensions of the magazine parts as well asthe clips themselves.

In addition, the full forward movement of ratchet connecting member 50has caused clip feed blade 18 to travel through much of upper jawportion 32 and lower jaw portion 34 and thereby place clip 37' at theextreme end of jaw portions 32 and 34. Thus, this full forward movementof ratchet member 50 has placed a clip in the loaded position in jawportions 32 and 34 so that it is now ready to be placed about a bloodvessel or the like.

It can also be seen in FIG. 11 that another hemostatic clip 37" has nowbeen moved into the key position 125 so as to be available during thenext spring activated loading sequence. It is important to note thatclip 37" is resting on platform 116 of lower ratchet bar 110 and is heldin place by guide spring 100 and leaf spring 112. Platform 116 preventsone or both legs of clip 37" from becoming disoriented within keyposition 125. Furthermore the downward taper of upper ratchet bar 70guides the line of clips down to key position 125 and helps prevent therearward clips from passing up and over the forward clips as the clipsare driven forward. A safety stop 152 at the end of housing 114 preventsthe clips from being ejected out of the housing by the forward motion ofthe lower ratchet bar 110 and pawl 122.

FIG. 12 is a cross-sectional side view of clip magazine 102 where, justas in FIG. 11, connecting member 50 has been brought to its full forwardposition. Cover plate 96 and upper ratchet bar 70 are not shown forclarity. Here, it can be seen that lower ratchet bar extension member109, which is abutting the right most portion of lost motion slot 84,has now been moved forward by the forward movement of clip feed blade18. The forward movement of ratchet extension member 109 has causedlower ratchet bar 110 to also move forward. Because lower tab 78 of pawl122 is disposed in hole 82' of ratchet bar 110, the forward movement ofratchet bar 110 has resulted in the forward movement of pawl 122. Then,this forward movement of pawl 122 has caused the series of clips 37contained in magazine 102 to also move forward. Furthermore, thiscontinued forward movement of ratchet connecting member 50 has causedclip feed blade 18 to guide clip 37' through jaw portions 32 and 34 tothe extreme portions thereof.

Now turning to FIG. 13, the configuration of spring activated clipapplying device 2 while a hemostatic clip 37' is being crimped isillustrated. Due to the movement of lower finger loop 6 toward upperfinger loop 4, and the resulting pivoting of upper jaw portion 32 aroundpivot 36, upper jaw portion 32 is moved toward lower jaw portion 34 soas to crimp hemostatic clip 37'.

There are two important occurrances to be noted as the result of thiscrimping operation illustrated in FIG. 13. First, it can be seen thatforked ends 21 of feed blade 18 are simultaneously being retracted fromjaw portions 32, 34 while being bent toward one another by the closingof jaw portions 32, 34. Second, as lower finger loop 6 is moved towardupper finger loop 4, energy is again being stored in ratchet spring 58by the retraction of ratchet connecting member 50. This retractingmovement of ratchet member 50 is caused by the movement induced by camfollower 62. As illustrated in FIG. 13, in phantom, cam follower 62 ofratchet connecting member 50 is coupled to lower finger loop member 7via camming surface 26. Thus, as lower finger loop 6 is moved upward,camming surface 26 engages cam follower 62 so as to cause a retractingforce to be applied to cam follower 62 and a corresponding retraction ofratchet member 50. That is, as finger loop 6 is lifted toward fingerloop 4, the ratchet connecting member 50 is retracted. This retractioncauses a stretching of spring 58 and results in a storage of energytherein.

It has been found that the freely spinning roller wheel 47 (FIG. 4) ofthe cam follower 62 together with the camming surface 26, provides animproved cocking mechanism for cocking spring 58. The resistance exertedby this mechanism to the closing of the finger loops is relatively smallwhich contributes to the natural "feel" of the device. Furthermore, itis seen that the displacement of the ratchet connecting member, for eachincremental movement of the finger loops together, can be selected bythe particular shape of the camming surface 26 provided.

Although the cam follower 62 has been shown as a freely spinning wheel,it is recognized that other low friction cam follower devices may beused. For example, a fixed surface coated with teflon or other lowfriction plastics may be used to engage the camming surface 26.

As spring 58 is cocked, any forward movement of ratchet member 50 isprevented by the interaction of latch 54 with ratchet member 50. Becausethe lower edge 9 of lower finger loop member 7 is no longer interactingwith latch 54, and because latch spring 56 is causing acounter-clockwise rotational movement of latch 54 about latch pivot 55,latch 54 is caught in one of the various ratchet teeth 52 disposed onthe lower edge of ratchet member 50. As ratchet member 50 is retracted,latch 54 rides up and over each of the inclined teeth 52 of ratchetmember 50 so as to continue to prevent forward movement of ratchetmember 50. Of course, a variety of other mechanisms could be used inplace of the ratchet member 50 and latch 54 so as to provide areleasable impediment to movement.

The lower finger loop member 7 has a tab 154 which overlaps the mainbody 20 and cover plate 22 to help prevent them from spreading from thelower finger loop member 7 as the finger loops are squeezed together tocrimp the clips. A similar overhanging tab (not shown) is provided forthe same purpose at the other end of lower finger loop member 7 adjacentjaw portions 32 and 34.

FIGS. 14 and 15 illustrate in greater detail the relationship of feedblade 18, lower ratchet bar 110 and upper ratchet bar 70 when thecocking and crimping motion of instrument 2 is more advanced than theconfiguration illustrated in FIG. 13. In comparison with FIG. 11, it canbe seen in FIG. 14 that clip feed blade 18 has been moved in therearward direction by the retracting motion of the ratchet connectingmember 50. This rearward movement has caused the forked ends 21 of clipfeed blade 18 to retract from jaw portions 32, 34, and the bending offorked ends 21 toward one another as jaw portions 32 and 34 converge.

Further, comparison of FIGS. 11 and 14 will disclose that lost motionextension member 109 has traveled the length of the lost motion slot 84contained in feed blade 18. Because lost motion member 109 is a part oflower ratchet bar 110, this rearward movement of extension member 109through lost motion slot 84 has resulted in little or no rearwardmovement of lower ratchet bar 110. Of course, the further rearwardmovement of feed blade 18 has caused a corresponding rearward movementof ratchet bar 110 due to the abutment of lost motion extension member109 with the forward most section of lost motion slot 84. Ultimately,further rearward movement will be prevented when stop 16 on lowerratchet bar 110 abuts rear stop 13. The prevention of additionalrearward movement of lower ratchet bar 110 also prevents furtherrearward movement of feed blade 18 due to the coupling thereof byextension member 109. The abutment of stop 16 with stop 13 is designedto coincide with the engagement of the cam follower 62 with the "flat"area 98 (FIG. 13) of camming surface 26. At area 98, the camming surface26 is actually curved at a constant radial distance from the pivot point36 such that the camming surface 26 at 98 no longer acts to retract theratchet member 50 when the ratchet spring 58 is fully cocked.

An additional advantage of the "flat" area 98 is that it allows thefinger loops 4 and 6 to be further closed to apply additional crimpingpressure if necessary on the clip 37' in the jaws 32 and 34, withoutinducing a further retracting force on the ratchet member 50 after theratchet spring 58 is fully cocked. This allows variable crimping forcesto be applied as needed, yet the spring 58 is fully cocked each time thecam follower 62 reaches the area 98 of camming surface 26.

It can also be seen in FIG. 14 that retraction of ratchet member 50 andthe corresponding retraction of feed blade 18 will allow clip 37" in keyposition 125 to drop onto housing 114 when feed blade 18 has exited keyposition 125. This rearward movement of feed blade 18 does not result inrearward movement of the clip 37" located in key position 125 becauseleaf spring 112 abuts the bail portion of clip 37" and thereby retainsclip 37" in the key position 125.

In addition, rearward movement of clip feed blade 18 and lower ratchetbar 110 does not create rearward movement of the pawl 122 and the otherclips 37. Pawl 122 is held stationary by upper tab 80 after tab 80slides backward and into hole 94" of upper ratchet bar 70, as shown inFIG. 14. As previously mentioned, the upper ratchet bar 70 does not movebut is affixed to housing 114. Note that hole 94" of upper ratchet bar70 is adjacent hole 94' in which the upper tab 80 was previouslydisposed. Thus, when lower ratchet bar 110 moves rearward, pawl 122 isheld stationary when pawl upper tab 80 engages upper ratchet bar hole94", while its lower tab portion 78 moves outward so that lower ratchetbar 110 slides under pawl 122. When clip feed blade 18 and lower ratchetbar 110 have returned to their rear-most position, lower tab portion 78of pawl 122 will be past the next hole 82" of lower ratchet blade 110.Note, the hole 82" is adjacent the hole 82' where lower tab 78previously was disposed. Thus the magazine is returned to theconfiguration shown in FIG. 8 except that the clip loaded in front ofthe clip feed blade 18 is now the next clip 37". In addition, the pawl122 has been advanced such that the upper tab 80 is disposed in theupper ratchet bar hole 94" and the lower tab 78 is just ahead of thelower ratchet bar hole 82". In this manner, sequential forward andrearward movement of ratchet bar 110 causes pawl 122 to progressivelymove forward, from one upper ratchet bar hole 94, to the next hole 94and from one lower ratchet bar hole 82 to the next hole 82. In addition,the sequential forward and rearward ratchet bar 110 movement causes theupper pawl tab 80 to engage an upper bar hole 94 during rearward ratchetbar movement alternating with lower pawl tab 78 engagement with a lowerratchet bar hole during forward movement. Such progressive movement ofpawl 122 causes, in turn, the progressive forward movement of clips 37.

Thus it is seen that as finger loop 6 is brought toward finger loop 4,upper jaw portion 32 is caused to abut lower jaw portion 34, and therebycompletely crimp hemostatic clip 37'. This movement of lower finger loop6 toward upper finger loop 4 has also caused the complete retraction ofratchet member 50 due to the engagement of cam follower 62 by cammingsurface 26. As a consequence of the counter-clockwise rotational forceapplied by latch spring 56, latch 54 continues to prevent the forwardmovement of ratchet 50. Thus, in this position, the energy has beenrestored in ratchet spring 58, so as to be available for subsequentinstanteous feeding of a hemostatic clip 37 into the jaws 32, 34.

Because the pawl 122 is held stationary against rearward movement onlyby the upper tab 80 engaging a hole of the upper ratchet bar 70,relatively little force is required to drive the pawl forward. Theresiliency of upper tab 80 is such that little force is required to bendit down as the pawl moves forward and upper tab 80 is disengaged fromthe upper ratchet bar hole. As a result, a weaker ratchet spring 58 maybe utilized and consequently, the force needed to cock the spring iscorrespondingly reduced. This factor also contributes to the naturalfeel provided by the instrument of the presen invention.

It can be seen from the above description in conjunction with theassociated illustrations, that the improved spring activated clipapplying device 2 of the present invention provides an automatic andrapid feeding of hemostatic clips 37 into the jaws of the instrument 2.With only the slightest downward movement of finger loop 6, a clip isalmost instanteously delivered to the jaw portions 32, 34. Then, simplyby moving finger loops 4 and 6 toward one another, a hemostatic clip 37which has been loaded in the jaw portions 32, 34 can be deformed arounda blood vessel or the like. Simultaneously with this crimping of thehemostatic clip 37, the instrument is again storing energy in a springso that when another clip is needed, it can be readily available. Thisprocess of inward and outward movement of finger loops 4 and 6 may berepeated rapidly, so that one vessel after another is closed byhemostatic clips 37, until the supply of clips in magazine 102 isdepleted.

Even with this additional feature of almost instantaneous loading ofhemostatic clips, the clip applying device 2 of the present inventionprovides the further advantages of high visibility to the user. Becausethe device 2 is of an extremely thin design, essentially the width ofcurrently used hemostats, and because jaw portions 32 and 34 are curvedaway from the main body 20, and finally because the clip feed blade 18is divided into thin forked sections 21 at its extreme end, a surgeonusing clip applying device 2 will have a clear view of the vessel he isclosing.

Furthermore, the clip applying device of the present invention closelysimulates the feel which is provided by a conventional hemostat in whichclips are manually inserted into the jaws of the hemostat. Devices whichdepart radically from the look and feel of conventional manualpliers-like hemostats have met significant resistance on the part ofsurgeons.

There has been described herein a new and novel clip applying devicewhich has special utility for applying hemostatic clips to blood vesselsand the like. However, it is to be understood that various alternateembodiments using the principles of the present invention may be readilyincorporated. Thus, while specific embodiments of the present inventionhave been disclosed and described in detail herein, it will beunderstood by those skilled in the art that various changes in form anddetail may be made therein without departing from the spirit and scopeof the invention.

What is claimed is:
 1. A clip magazine for a surgical clip applyingdevice comprising:a housing wherein a plurality of clips are stored;clip feed means for sequentially ejecting clips from the housing; andclip loading means for sequentially loading clips to the clip feedmeans, said clip loading means including a first ratchet bar coupled tothe housing, a second ratchet bar coupled to the clip feed means andadapted to be moved in a reciprocating forward and rearward motion, andpawl means for urging the clips through the housing, said pawl meanshaving means for alternately engaging the second ratchet bar as thesecond ratchet bar moves forward such that the pawl means is movedforward with the second ratchet bar, and for engaging the first ratchetbar as the second ratchet bar moves rearward to prevent rearwardmovement of the pawl means.
 2. The clip magazine of claim 1 wherein eachratchet bar has a plurality of recesses and the engaging means of thepawl means includes a first tab portion for engaging a recess of thefirst ratchet bar to prevent the pawl means from moving rearward and asecond tab portion for engaging a recess of the second ratchet bar asthe second ratchet bar moves forward.
 3. The clip magazine of claim 1wherein the first and second ratchet bars are positioned parallel withrespect to each other and define a groove therebetween for slidinglyholding the plurality of clips arranged in a longitudinal line withrespect to the ratchet bars.
 4. A clip magazine for a surgical clipapplying device comprising:a housing wherein a plurality of clips arestored; clip feed means for sequentially ejecting clips from thehousing; and clip loading means for sequentially loading clips in theclip feed means, said clip loading means including a first ratchet barcoupled to the housing, a second ratchet bar coupled to the clip feedmeans, and pawl means engaging the ratchet bars, for urging the clipsforward through the housing, said first and second ratchet bars eachhaving a plurality of recesses disposed therein and said pawl meanshaving first and second resilient tab portions adapted to alternatelyengage the recesses of the first and second ratchet bars such thatforward movement of the second ratchet bar causes forward movement ofthe pawl means by the engagement of the second tab portion with a recessof the second ratchet bar, and rearward movement of the pawl means, whenthe second ratchet bar moves rearward, is prevented by the engagement ofthe first tab portion with a recess of the first ratchet bar.
 5. A clipmagazine for a surgical clip applying device, comprising:a first ratchetbar having a plurality of apertures; a second ratchet bar having aplurality of apertures; and a pawl for engaging the rearward most clipof a line of clips, said pawl having a first resilient tab adapted toengage an aperture of the first ratchet bar and a second resilient tabadapted to engage an aperture of the second ratchet bar; wherein forwardmovement of the second ratchet bar causes the second pawl resilient tabto engage an aperture of the second ratchet bar so that the forwardmovement of the second ratchet bar moves the pawl and the clips forward,and a subsequent rearward movement of the second ratchet bar causes thesecond pawl resilient tab to disengage the second ratchet bar and thefirst pawl resilient tab to engage an aperture of the first ratchet barto prevent further rearward movement of the pawl.
 6. A clip magazine fora surgical clip applying device, comprising:first and second ratchetbars positioned parallel with respect to each other and defining agroove therebetween for slidingly holding a plurality of clips arrangedin a longitudinal line with respect to the ratchet bars, each barfurther defining a plurality of recesses aligned generally parallel tosaid longitudinal line; means for reciprocatingly moving the ratchetbars relative to each other in a direction parallel to the longitudinalline; and pawl means, positioned between the first and second ratchetbars, for alternately engaging the recesses of the reciprocating firstand second ratchet bars to urge the clips through the groove.
 7. In aclip magazine for holding a plurality of surgical clips for a surgicalclip applying device, the improvement comprising:ratchet means foradvancing the clips through the magazine, said ratchet means definingfirst and second sets of recesses and having pawl means for alternatelyengaging the first and second sets of recesses and for sequentiallyengaging the recesses of both sets of recesses in response toreciprocating forward and rearward motion of one set of recessesrelative to the other wherein the clips are progressively driven forwardby the pawl means which is progressively driven forward by thereciprocating motion of said one set of recesses and the alternating andsequential engagement of the pawl means with the recesses.
 8. Ahemostatic clip magazine for a hemostatic clip applicator comprising:ahousing wherein a plurality of clips are stored in a line, said housinghaving an exit through which the clips move to the applicator; and clipadvancement means within the housing for advancing the line of clips tothe housing exit, said clip advancement means including a first ratchetbar coupled to the housing, a second ratchet bar adapted to be moved ina reciprocating forward and rearward motion, and pawl means for engagingthe last clip of the line of clips, said second ratchet bar having meansfor engaging the pawl means as the second ratchet bar moves forward sothat the pawl means is moved forward with the second ratchet bar therebyadvancing the line of clips, and said first ratchet bar having means forengaging the pawl means as the second ratchet bar moves rearward toprevent rearward movement of the pawl means and the line of clips.
 9. Aclip magazine for a surgical clip applying device, comprising:a firstsubstantially flat ratchet bar having a plurality of spaced apertures ina line; a second substantially flat ratchet bar having a plurality ofspaced apertures in a line, said second bar being adapted for forwardand rearward movement relative to the first ratchet bar; a plurality ofhemostatic clips stored in a line and lying flat between the first andsecond bars wherein the apertures of the first and second bars arespaced a distance approximately equal to the length of each clip, saidfirst and second bars have a width approximately equal to the width ofthe clips and said first and second bars are positioned parallel to oneanother within the magazine and are spaced a distance slightly greaterthan the thickness of the clips to guide the line of clips between thefirst and second bars; and a pawl positioned between the first andsecond bars for engaging the rearward most clip of the line of clips andfor moving the line of clips forward, said pawl having first and secondresilient tabs adapted to alternately engage an aperture of the firstratchet bar upon rearward movement of the second bar, and an aperture ofthe second bar upon forward movement of the second bar, respectively, sothat the pawl and the line of clips advance forward with each forwardmovement of the second bar.
 10. A hemostatic clip magazine for ahemostatic clip applicator having clip deforming jaws, comprising:firstand second ratchet bars positioned parallel with respect to each otherand defining a groove therebetween for slidingly holding a plurality ofclips arranged in a longitudinal line with respect to the ratchet bars,each bar further defining a plurality of recesses aligned generallyparallel to said longitudinal line, said second bar being adapted forforward and rearward movement, a feed blade adapted for reciprocatingforward and rearward movement, said blade having an end adapted toengage a clip and move a clip from the magazine to the clip deformingjaws; lost motion means for coupling the feed blade to the second bar sothat reciprocating forward and rearward movement of the feed bladecauses a smaller reciprocating forward and rearward movement of thesecond bar; and pawl means, positioned between the first and secondratchet bars, for engaging the rearward most clip of the line of clipsand for alternately engaging the recesses of the first and secondratchet bars as the second bar reciprocates rearward and forward,respectively, to urge the clips forward through the groove.